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SMJ // Article

Case Report

Disseminated Mycobacterium avium intracellulare Infection in an “Immunocompetent” Host

Authors: Kennedy K. Eneh, MD, Mehjabin Zahir, MD, Maximo E. Mora, MD, Frances Schmidt, MD, Danilo Enriquez, MD, Fadi Hammoudeh, MD, Narayan Neupane, MD, Joseph Quist, MD

Abstract

We are reporting the case of a 37-year-old immunocompetent patient who presented with anterior chest wall swelling, jaw swelling and pain, back pain, night sweats, and unintentional weight loss. He underwent mediastinoscopy with lymph node biopsy, which revealed caseating and noncaseating granuloma and special stains positive for acid-fast bacteria. Cultures from two different sites surprisingly grew Mycobacterium avium intercellulare (MAI), and a diagnosis of disseminated MAI was made. He was switched from antituberculous treatment to MAI treatment.


Key Points


* Disseminated NTM has been reported in immunosuppressed patients with renal or cardiac transplantation, chronic corticosteroid use, and leukemia.


* Rare genetic disorders may be associated with disseminated NTM infection.


* Our patient was started on antituberculous medication for suspected pulmonary tuberculosis with good response, but, after undergoing mediastinal lymph node biopsy, he was found to have necrotizing and nonnecrotizing granuloma with special stains positive for acid-fast bacteria.

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